Kids Summer Art Camp Information Form Student Registration InformationChild's First Name(Required) Child's Last Name(Required) Child's Birthdate(Required) MM slash DD slash YYYY Child's T-shirt Size Child's Allergies and/or Medications (n/a if not applicable) Student #2 Registration InformationChild #2 First Name Child #2 Last Name Child #2 Birthdate MM slash DD slash YYYY Child #2 T-shirt Size Child #2 Allergies and/or Medications (n/a if not applicable) Student #3 Registration InformationChild #3 First Name Child #3 Last Name Child #3 Birthdate MM slash DD slash YYYY Child #23 T-shirt Size Child #3 Allergies and/or Medications (n/a if not applicable) Considerations or AccomodationsLearning or Developmental Considerations or Accommodations for any of your enrolled children? Please explain: Any food Allergies? Parent/Guardian InformationParent/Guardian Name(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) Emergency Contact (if different from above) First and Last NameEmergency Contact's Relationship to Child Emergency Contact's Phone Number This person DOES NOT have permission to pick up my child Consent(Required) Check Box I acknowledge and agree to my child(ren)'s participation in class activities and understand the risks involved in the utilization of art supplies, including personal injury and property damage, and I release the Long X Arts Foundation from any and all responsibility therein.Photo Release:(Required) Yes No I hereby grant the Long X Arts Foundation permission to use group or individual photographs or images taken during classes or events for publicity or promotional purposes:
